Healthy lifestyle index and the risk of ductal carcinoma in situ of the breast in the Women's Health Initiative

Rita Peila; Dorothy S Lane; Aladdin H Shadyab; Nazmus Saquib; Howard D Strickler; JoAnn E Manson; Kathy Pan; Thomas E Rohan

doi:10.1002/ijc.34034

Healthy lifestyle index and the risk of ductal carcinoma in situ of the breast in the Women's Health Initiative

Int J Cancer. 2022 Aug 15;151(4):526-538. doi: 10.1002/ijc.34034. Epub 2022 May 6.

Authors

Rita Peila¹, Dorothy S Lane², Aladdin H Shadyab³, Nazmus Saquib⁴, Howard D Strickler¹, JoAnn E Manson⁵, Kathy Pan⁶, Thomas E Rohan¹

Affiliations

¹ Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York City, New York, USA.
² Department of Family, Population & Preventive Medicine, Renaissance School of Medicine Stony Brook University, Stony Brook, New York, USA.
³ Herbert Wertheim School of Public Health and Human Longevity Science, University of California-San Diego, La Jolla, California, USA.
⁴ College of Medicine at Sulaiman, Al Rajhi University, Al Bukayriyah, Saudi Arabia.
⁵ Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁶ Department of Hematology/Oncology, Kaiser Permanente Southern California, Downey, California, USA.

PMID: 35429338
DOI: 10.1002/ijc.34034

Abstract

A relatively high healthy lifestyle index (HLI) score, representing a healthy diet, participation in moderate to vigorous physical exercise, no smoking, low to no alcohol intake and a normal body mass index, has been associated with a reduced risk of invasive breast cancer. However, no study has shown an association between the HLI and the risk of ductal carcinoma in situ of the breast (DCIS), which is considered to be a nonobligate precursor of invasive breast cancer. We evaluated this association in a prospective cohort of 132 230 postmenopausal women, aged 50 to 79 years, recruited between 1993 and 1998 across the United States and enrolled in the Women's Health Initiative study. The HLI score was created and categorized into quartiles. During an average follow-up of 15.4 years, 2035 DCIS cases were ascertained. Multivariable-adjusted Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association of HLI with the risk of DCIS. Women in the highest HLI quartile had a lower DCIS risk than those in the lowest quartile (HR_4thQT = 0.80, 95% CI, 0.70-0.92) and this association was stronger in women with a family history of breast cancer (HR_4thQT = 0.70, 95% CI, 0.52-0.93), and for ER+/PR+ DCIS (HR_4thQT = 0.66, 95% CI, 0.52-0.83). These findings suggest that there is an inverse association between HLI and risk of DCIS, and suggest that the adoption of a healthy lifestyle might lower the risk of DCIS.

Keywords: ductal carcinoma in situ; healthy lifestyle index; postmenopausal women; prospective study.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Breast Neoplasms* / epidemiology
Breast Neoplasms* / etiology
Breast Neoplasms* / pathology
Carcinoma, Ductal, Breast* / epidemiology
Carcinoma, Ductal, Breast* / pathology
Carcinoma, Intraductal, Noninfiltrating* / epidemiology
Carcinoma, Intraductal, Noninfiltrating* / pathology
Female
Healthy Lifestyle
Humans
Prospective Studies
Risk Factors
United States / epidemiology
Women's Health